Nursing Elites

1. When using the Ballard gestational assessment tool on a newborn, which of the following tests should be performed after the first hour of birth, allowing the newborn to recover from the stress of birth?

• A. Arm recoil
• B. Square window sign
• C. Scarf sign
• D. Popliteal angle

Correct answer: A

Rationale: The correct answer is Arm recoil. Arm recoil is slower in healthy but fatigued newborns after birth, making it best elicited after the first hour of birth when the baby has had time to recover from the stress of birth. This assessment helps evaluate neuromuscular maturity in newborns and is more accurate when performed after the initial recovery period. The other choices, Square window sign, Scarf sign, and Popliteal angle, are not specifically assessed using the Ballard gestational assessment tool and do not relate to the recovery period after birth.

2. You arrive at the scene shortly after a 3-year-old female experienced a seizure. The child, who is being held by her mother, is conscious and crying. The mother tells you that her daughter has been ill recently and has a temperature of 102.5°F. What is the MOST appropriate treatment for this child?

• A. Oxygen via non-rebreathing mask, place the child in a tub of cold water to lower her body temperature, and transport.
• B. Oxygen via the blow-by technique, transport, and request a paramedic intercept so an anticonvulsant drug can be given.
• C. Oxygen via non-rebreathing mask, avoid any measures to lower the child's body temperature, and transport at once.
• D. Oxygen via the blow-by technique, remove clothing to help reduce her fever, and transport with continuous monitoring.

Correct answer: D

Rationale: The most appropriate treatment for a child who has experienced a seizure and has a fever includes administering oxygen via the blow-by technique, removing clothing to help reduce fever, and transporting the child with continuous monitoring. Choice A is incorrect because placing the child in a tub of cold water can lead to hypothermia and is not recommended for fever reduction. Choice B is incorrect as requesting an anticonvulsant drug without proper evaluation and assessment by a healthcare provider is not appropriate. Choice C is incorrect as avoiding measures to lower the child's body temperature can worsen the situation in case of febrile seizures. Therefore, the best course of action is to provide oxygen via the blow-by technique, remove excess clothing to reduce fever, and transport the child while continuously monitoring her condition.

3. In contrast to the contractions associated with true labor, Braxton-Hicks contractions:

• A. generally follow rupture of the amniotic sac and occur with regularity.
• B. may be intensified by activity and are accompanied by a pink discharge.
• C. do not increase in intensity and are alleviated by a change in position.
• D. consistently become stronger and are not alleviated by changing position.

Correct answer: C

Rationale: Braxton-Hicks contractions are irregular and usually do not increase in intensity. Unlike true labor contractions, they tend to alleviate with a change in position, making option C the correct choice. Choices A, B, and D are incorrect because Braxton-Hicks contractions do not follow rupture of the amniotic sac, are not intensified by activity or accompanied by a pink discharge, and do not consistently become stronger or are not alleviated by changing position.

4. Following an apparent febrile seizure, a 4-year-old boy is alert and crying. His skin is hot and moist. Appropriate treatment for this child includes:

• A. allowing the parents to transport the child.
• B. offering oxygen and providing transport.
• C. rapidly cooling the child in cold water.
• D. keeping the child warm and providing transport.

Correct answer: B

Rationale: After a febrile seizure, the priority is to offer oxygen and provide transport to a medical facility. Oxygen may be necessary to ensure proper oxygenation, and medical evaluation is crucial to determine the cause of the seizure and prevent recurrence. Rapidly cooling the child in cold water is not recommended as it may lead to complications such as hypothermia. Keeping the child warm is also not indicated as the skin is already hot and moist. Therefore, offering oxygen and timely transportation to a healthcare facility is the most appropriate course of action. Allowing the parents to transport the child might delay necessary medical care, and keeping the child warm can exacerbate the existing heat. Rapidly cooling the child in cold water can lead to adverse effects, making it an inappropriate choice.

5. When educating the mother of a child with respiratory disease who needs a lot of fluids, the mother tells the nurse that when she offers her 24-month-old son juice, he always shakes his head and says, 'No'. The nurse suggests that the mother:

• A. Be firm and hand him the glass
• B. Distract him with some food
• C. Let him see that he is making her angry
• D. Offer him a choice of two things to drink

Correct answer: D

Rationale: Offering a choice can help the child feel more in control and willing to drink. By providing the child with options, the mother empowers him to make a decision, which can increase his willingness to drink fluids. This approach promotes a sense of autonomy and may lead to a more positive response from the child, ultimately contributing to better fluid intake, especially important for a child with a respiratory disease.

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